New Senior Care Pharmacy Coalition: Stop Use of Prorated or Daily Dispensing Fees | Commentary

Every day, seniors and rehab patients in skilled nursing centers and assisted living facilities across America benefit from the specialized guidance and clinical oversight that only long-term care (LTC) pharmacies, and the consulting pharmacists they employ, can provide. Among other essential responsibilities, LTC pharmacies ensure that complex prescription drug regimens are properly filled and professionally reviewed for safety, accuracy, compliance and prevention of dangerous adverse drug interactions.

As leaders of both parties in the new 114th Congress rightfully seek higher quality care, better patient outcomes and lower costs, LTC pharmacies can, and should, play an increasingly important role. As a newly formed coalition of independent LTC pharmacies with a diverse membership representing facilities across the country, among the Senior Care Pharmacy Coalition’s key objectives will be to ensure the pharmacies and the patients they serve are protected from the debilitating effects of increasingly secretive, opaque reimbursement policies.

These abusive practices offer no recourse for pharmacies to ensure they are appropriately reimbursed for the drugs they dispense. This results in the inappropriate shifting of Medicare dollars from the pharmacists actually providing the care to intermediaries, such as Pharmacy Benefit Managers. This undermines LTC pharmacies’ ability to innovate, and to provide the key consultative services that Medicare stipulates, and seniors require as the broader provider community works to optimize outcomes.

An example of these harmful practices is the unilateral decision by the nation’s two largest PBMs to stop paying pharmacies a flat, monthly professional dispensing fee every time they fill a prescription and instead pay them a so-called “daily dispensing fee,” linked solely to the amount of medication they dispense. These prorated fees ignore the unique, protective professional services that LTC pharmacists offer their nursing home patients every time they fill a prescription and, left unchecked, they impede the migration to shorter dispensing cycles in LTC settings. The result is higher costs for taxpayers and more threat to the environment.

Sens. Benjamin L. Cardin, D-Md., and Barbara A. Mikulski, D-Md., introduced the Medicare Efficient Drug Dispensing Act in the last session of Congress to restore the professional dispensing fee and encourage the use of dispensing techniques that foster efficiency and reduce waste. Specifically, the legislation prohibits Medicare Part D plan sponsors from using payment structures — including prorated daily dispensing fees — that discourage the adoption of techniques designed to minimize the dispensing of unused drugs.

As the legislative agenda unfolds in 2015, the SCPC intends to work with its sponsors to reintroduce this legislation, and ensure it receives wider exposure and bicameral, bipartisan support. Ultimately, federal laws and regulations that help to increase transparency, improve outcomes for the growing cohort of America’s most vulnerable seniors, and promote the more efficient use of taxpayer dollars, will gain bipartisan legislative support on the merits. The Medicare Efficient Drug Dispensing Act meets these criteria, and we will aggressively make this case throughout the 114th Congress.

Alan G. Rosenbloom is president and CEO of the Senior Care Pharmacy Coalition, and former president of the Alliance for Quality Nursing Home Care and Pennsylvania Health Care Association.